The modified buccal musculomucosal flap method for cleft palate surgery

Area of Science:

• Plastic Surgery
• Pediatric Surgery
• Craniofacial Surgery

Background:

• The T-shaped musculomucosal buccal flap method for cleft palate repair has shown success in over 90 patients regarding maxillary development, fistula prevention, and speech.
• However, 14.3% of patients developed velopharyngeal incompetence unresponsive to training, often due to incomplete oral surface coverage by the flap, causing soft palate contraction.

Purpose of the Study:

• To introduce and evaluate a modified surgical technique for primary cleft palate repair.
• To overcome the limitations of the previous T-shaped musculomucosal buccal flap method, specifically addressing soft palate contraction and velopharyngeal incompetence.

Main Methods:

• A new surgical approach was developed utilizing both buccal musculomucosal flaps for oral lining.
• Nasal mucosa was extended using Z-plasty to ensure complete coverage.
• This modified technique was performed on 25 patients.

Main Results:

• The modified technique resulted in no instances of postoperative soft palate contraction in 25 patients.
• Two cases (8.0%) experienced postoperative fistulation, a slight increase compared to the previous method.
• No cases of velopharyngeal incompetence were reported in this series.

Conclusions:

• The modified T-shaped musculomucosal buccal flap technique with Z-plasty extension effectively prevents postoperative soft palate contraction.
• This approach shows promise in reducing velopharyngeal incompetence following cleft palate repair.
• Further evaluation is warranted to optimize fistula rates.